Sr. Disability & Leave Management (Group Insurance) Claims Examiner (REMOTE)

About The Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we’ve honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required. What You’ll Be Doing • Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved • Communication via telephone, email, and text with employees, employers, attorneys, and others • Review and interpret medical records, utilizing resources as appropriate • Complete financial calculations • Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication • Apply contract/policy provisions to ensure accurate eligibility and liability decisions • Demonstrate and apply analytical and critical thinking skills • Verify on-going liability and develop strategies for return-to-work opportunities as appropriate • Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication • Leverage a broad spectrum of resources, materials, and tools to render claims decisions • Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards • Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities • Work independently as well as within a team structure • Deliver refresher trainings as appropriate to the claim team • Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review. • Prepare reports for management on claim outcomes and performance metrics. • Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills. • Oversee the ongoing management of complex, high-priority or escalated cases and callers. Remote – This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs. The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits: Equitable Total Rewards Program What You Will Bring • Bachelor’s degree or equivalent work experience • 3+ disability claims administration experience • Prior leadership experience as a team lead or manager • Exceptional customer service skills • Maintains positive and effective interaction with challenging customers • Strong knowledge of disability and leave laws and regulations • Ability to handle sensitive information with confidentiality and professionalism • Group Disability Claims experience • Prior experience managing Paid Family Leave for multiple state Preferred Qualifications • Experience working with the Fineos Claim Management System • Exceptional written and oral communication skills demonstrated in previous work experience • Excellent organizational and time management skills with ability to multitask and prioritize deadlines • Ability to manage multiple and changing priorities • Detail oriented; able to analyze and research contract information • Demonstrated ability to operate with a sense of urgency • Experience in effectively meeting/ exceeding individual professional expectations and team goals • Demonstrated analytical and math skills • Ability to exercise critical thinking skills, risk management skills and sound judgment • Ability to adapt, problem solve quickly and communicate effective solutions • High level of flexibility to adapt to the changing needs of the organization • Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment • Continuous improvement mindset • A commitment to support a work environment that fosters diversity and inclusion. • Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word Skills Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. About Equitable At Equitable, we’re a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more. Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at (212) 314-2211 or email us at [email protected]. Primary Location UNITED STATES-Remote Other Locations UNITED STATES-NC-Charlotte, UNITED STATES-NY-Syracuse Organization Equitable Schedule Full-time Apply tot his job